Miller's Spine Flashcards by Mark Plumby

axis of rotation of compression fx

middle column

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MOA for Burst fx

axial

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Axis or rotation for flexion and distraction

anterior longitudinal ligament

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burst fc in pt that is neuro intact with minimal deformity

- board brace answer?

can be treated in extension bracing

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Burst

- ant vs post?

Ant- neuro deficit with retropulsion

post - multiseg fication, lamina fx

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bony chance
ligamentous chance
Treatment for each

extension bracing

posterior tension band

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% of those with asymptomatic disc herniation on MRI

25-37%

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movement causing disc pain

movement causing facet pain

disc-> flexion

facet-> extension

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most sensitive method for detecting isthmic spondy

SPECT

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nerve that innervates facet joint

medial branch of dorsal primary rami and sinuvertebral n

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most common nerve affected with L5/S1 isthimic spondy

- whats it from

exiting L5 nerve root

- due to a fibrocartilaginous reparative process under the pars

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causes of iatragenic isthimic spondy

burr through the pars
removal of 100% of one facet
removal of 50% of bilateral facet

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treatment for lateral recess stenosis

- causes unilateral nerve root pain

medial facetectomy

- preserve the pars

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Surgical treatment for thoracic HNP

costotransversectomy
transthoracic approach

isolated laminectomy NOT the answer

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main cause of epidural abscess

clinical presentation compared to diskitis

operative cause
ESI
Lumbar puncture
more systemically ill

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contents of carotid sheath

internal and common carotid a
internal jugular vein
vagus n

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finding on laryngoscope that suggest vocal cord is paralysized

Adducted -> abnormal

abducted they are normal

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Difference in injury to superior vs recurrent laryngeal n

superior
- upper cervical serugery
- high note phonation NOT vocal cord paralysis
recurrent causes vocal cord paralysis

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Benefit of TLSO over Jewett brace for thoracolumbar spin fx’s

TLSO gives more rotational control

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% of people with resolution of acute low back pain by 1 mos

90%

Most important predictor of successful outcome after diskectomy for lumbar HNP

+ straight leg raise

low Japanese score

higher level of dysfunction from cervical myelopathy

finding on MRI C spine indicative of permanent change to spinal cord

myelomalacia -> cord enhancement

limit of anterior surgery for myelopathy that indicates addition of posterior procedure

2 level corpectomy

3 or more levels that need addressed

location of screws for cervical fusion

C1- lateral mass C2- pedicle C3-6 - lateral mass C7 and down- pedicle

orientation of lateral mass screws in C spine

up and out - out avoids vertebral a - up avoids exiting nerve root

Cervical level when screws are oriented outward

Unique to each - anterior cervical - posterior cervical

anterior - dysphagia posterior - infection otherwise they have similar rates of other complications - C5 palsy, progressive myelopathy, durotomy

CA to play contact sport | - findings related to cervical stenosis

myelomalacia | CSF effacement

Indication for surgery for RA cervical C1/2 instability

ADI > 10mm PADI < 14mm progressive deficits

Indication for surgery for RA basilar invagination

progressive cranial migration | occiput to cervical fusion

% who improve from nonop of cervical radiculopathy

75%

Operative indication for cervical radiculopathy

NOT weakness -> this always improves | persistent and disabling pain for 6-12 wks after failed nonop

interval of ACDF

SCM lateral medial is strap muscles

Risk of adjacent segment disease after C spine fusion

1.5-4%

Neural crest -> Neural tube -> notocord ->

PNS, sympathetic trunk spinal cord vertebral bodies and disc

Positive signal in MEP/SEP

MEP - sustained > 75% decrease in MEP amp SEP - 50% decrease in am - 10% increase in latency

Radiograph to clear C spine

Either - XR: AP/lat and open mouth odontoid, gotta image top of T1 - CT to bottom of 1st thoracic T1 vertebra

how to tell difference btw spinal shock and neurogenic shock

both with bradycardia and hypotension | - neurogenic shock has intact bulbocavernosus reflex

indication for high dose steroid in SCI

NO LONGER INDICATED | - complications outweigh potential benefits

appropriate timing of surgery for spine injury in setting of SCI

incomplete w/in 12 hours | complete w/in 24 hours

When to operate on central cord

severe compression worsening exam with mild stenosis pre-exhisting myelopathy

HLA-B8

DISH

Treatment for cervical diskitis/epidural abcess

emergent decompression/stabilization

os odontoideum is a CA to...

contact sports

When to operate on type 2 odontoid < 50 yo > 50yo

< 50 ---> risk factors of nonunion > 50 --> already met criteria b'c they're older than 50 making at risk for nonunion

combined lateral mass overhang C1 on C2 that meets criteria of instability

> 7mm | >8.1mm with magnification

difference on lateral C spine xray to help determine diff btw unilateral vs bilateral jumped facet

unilateral vert body is 25% subluxed | bilateral will be 50% translated

when to do urgent closed reduction for jumped facet of c spine

bilateral and alert is only scenario if unilateral they get MRI first - reason is bilateral has the high risk of spinal cord injury so you want to do it ASAP - unilateral no rush, get MRI, then OR